BASICS FOR BALANCING

First Name:
Last Name:
Street Address:
City:  
State:  
Zip Code:  
County:
Home and/or cell Phone:
FAX:
E-Mail:
Date of Birth:
Place of Birth:
Basic Intentions (List several of your main goals):
Health Desires (What would you improve about your health):  
Prosperity (What financial gains and by when):
Lifestyle Improvements (home, new job, travel....):  
Relationship Improvement:
How many different Life Affirmations:
   
 

 

 

 

DISCLAIMER: None of the above is meant to diagnose, treat, prescribe or claim to cure any disease. Clients are advised that they should consult their own medical practitioners and medical professionals for the diagnoses, care, treatment or cure of any health condition.